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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Adenocarcinoma of the lower oesophagus and junction grows out of Barrett's oesophagus, the change in the lining caused by long-standing acid reflux. Chemotherapy or chemoradiation before surgery is standard, and HER2, PD-L1 and claudin 18.2 now guide drugs for advanced disease as they do in stomach cancer.
Oesophageal adenocarcinoma arises in the lower oesophagus and gastro-oesophageal junction from Barrett's oesophagus, driven by reflux, obesity and smoking; TP53 mutation, chromosomal instability and amplification of HER2, EGFR, MET or KRAS are typical. Barrett's surveillance and endoscopic ablation or resection of dysplasia prevent progression. Locally advanced disease is treated with perioperative FLOT chemotherapy, which the ESOPEC trial showed gives better survival than CROSS chemoradiation, followed by oesophagectomy. Advanced disease is managed with stomach cancer regimens: nivolumab or pembrolizumab with chemotherapy for PD-L1-positive tumours, trastuzumab with chemotherapy for HER2-positive tumours, zolbetuximab for claudin 18.2-positive tumours, and trastuzumab deruxtecan after HER2-directed therapy.
| Setting | Approach | Guideline |
|---|---|---|
| Barrett's oesophagus | Endoscopic surveillance; radiofrequency ablation or endoscopic resection for dysplasia and early cancer. | not mapped |
| Locally advanced | Perioperative FLOT (docetaxel, oxaliplatin, fluorouracil, leucovorin) and oesophagectomy, preferred over CROSS after ESOPEC; chemoradiation where chemotherapy is not tolerated. | not mapped |
| Advanced, first line | Nivolumab or pembrolizumab with platinum-fluoropyrimidine chemotherapy for PD-L1-positive tumours; trastuzumab with chemotherapy (and pembrolizumab) for HER2-positive tumours; zolbetuximab with chemotherapy for claudin 18.2-positive tumours. | not mapped |
| Later lines | Trastuzumab deruxtecan for HER2-positive disease; ramucirumab with paclitaxel; trifluridine-tipiracil. | not mapped |